Covid-19 can damage the lungs of patients who died from the disease so badly that the organs become unrecognisable, a top expert has warned.
Professor Mauro Giacca, from King’s College London, analysed autopsies of patients who died in Italy after spending more than a month in hospital.
He saw ‘complete disruption of the lung architecture’ in the patients, saying in some cases ‘you can’t even distinguish that it used to be a lung’.
The cardiologist told the House of Lords Science and Technology Committee that he saw ‘massive thrombosis’, or blood clots, in the lungs.
One in three people who fall severely ill with coronavirus develop dangerous blood clots, which scientists believe is contributing to their deaths.
The clots can become fatal if they migrate to major organs, like the lungs, and cut off their blood supply.
Severe coronavirus infection damages patients’ lungs beyond recognition, a leading expert has warned (file)
Professor Giacca told Peers: ‘What you find in the lungs of people who have stayed with the disease for more than a month before dying is something completely different from normal pneumonia, influenza or the Sars virus.
‘You see massive thrombosis. There is a complete disruption of the lung architecture – in some lights you can’t even distinguish that it used to be a lung.
‘There are large numbers of very big fused cells which are virus positive with as many as 10, 15 nuclei.
Professor Mauro Giacca, from King’s College London, observed ‘complete disruption of the lung architecture’ in those who spent more than a month in hospital fighting the virus
‘I am convinced this explains the unique pathology of Covid-19. This is not a disease caused by a virus which kills cells, which had profound implications for therapy.’
Professor Giacca warned that there were still high levels of the virus thriving in the lungs even after the patients had died.
He said this finding showed the potential for ‘real problems’ in patients who manage to survive.
One in three people who fall severely ill with coronavirus develop dangerous blood clots.
The blockages can trigger heart attacks, strokes, organ failure and pulmonary embolism, if they migrate to major organs.
Severe inflammation – an overreaction by the immune system to Covid-19 infection – is thought to be the cause of the blood clots.
Roopen Arya, a professor of thrombosis at King’s College London, said that while pneumonia was still the main cause of death in Covid-19 patients, doctors were now becoming ‘more and more aware’ of the problem.
Scientists aren’t sure why the virus causes clots – but they believe it could be the result of a an immune overreaction called a ‘cytokine storm’.
Cytokines are chemical-signaling molecules which guide a healthy immune response. They tell immune cells to attack viral molecules in the body.
But in some patients, this process goes into overdrive and immune cells begin destroying healthy tissues.
This can lead to damaged blood vessels which leak and cause blood pressure to plummet, driving up the chance of clots forming, according to Dr Jamie Garfield from Temple University Hospital in Philadelphia.
Other scientists say the clots be a byproduct of the way Covid-19 invades the human body.
Professor Ian Jones, a virologist at the University of Reading, told MailOnline: ‘Covid binds to an enzyme called ACE2 which is on the surface of the cell. It simply uses it as a way of attaching itself but in doing so the enzyme function of ACE2 is reduced.
‘The consequence of this is an imbalance of hormones called Angiotensin I and Angiotensin II which together regulate blood pressure. It could be related to the increase in strokes reported.’
Dr Robert Bonow, a professor of cardiology at Northwestern University, said it may be the coronavirus’ unique shape that is causing the blood clotting issues.
He told MailOnline: ‘With Covid-19 specifically, what you see that you don’t with the flu, is because under a microscope, coronavirus has all these spikes coming out of it, and those spikes are little proteins that are looking for receptors on the cells that they attach onto,’
‘It’s specifically looking for receptors in the lungs, but those same receptors sit on blood vessels, so it can attach on the lungs but also on blood vessels.’
Once they dock onto these blood vessel cells, the viral particles can trigger damage to these as well as to heart muscle, Dr Bonow says.
They can trigger ‘hypercoagual states,’ causing blood clots that lead to heart attacks.
If Covid-19 targets blood vessels, it could explain why people who already have damaged vessels – such as diabetes and high blood pressure patients – are more likely to fall critically ill.
Exactly how the virus attacks the blood vessels remains a mystery, but several scientific paper and pre-prints have shown the deadly side effect is common.
Chicago coronavirus survivor in her 20s with ‘a minor underlying health condition’ receives double-lung transplant after the virus left her organs ‘full of holes and almost fused to her chest’
Surgeons in Chicago have given a new set of lungs to a young woman with severe lung damage from the coronavirus.
Only a few other COVID-19 survivors, in China and Europe, have received lung transplants.
Doctors say the patient, a Hispanic woman in her 20s, was ‘pretty healthy’ before she caught coronavirus, although she’d been taking a drug with immune-suppressing effects for a minor health condition during the prior year.
After being sick for two weeks, she was placed on a ventilator and heart-lung machine the day she was admitted, and remained on them for almost two months before her operation last Friday at Northwestern Memorial Hospital.
The 10-hour procedure was challenging because the virus had left her lungs full of holes and almost fused to the chest wall, Dr Ankit Bharat, who performed the operation, said Wednesday.
Doctors have kept her on both machines while her body heals but say her chances for a normal life are good.
‘We are anticipating that she will have a full recovery,’ said Dr Rade Tomic, medical director of the hospital’s lung transplant program.
Already, ‘she’s awake, she’s smiling, she FaceTimed with her family,’ Dr Bharat told The New York Times.
This X-ray image shows the chest of a COVID-19 patient in her 20s before she received a new set of lungs because of severe lung damage from the coronavirus, at Northwestern Memorial Hospital in Chicago (left). Coronavirus left the woman’s lung blackened, riddled with holes (right) and nearly fused to her chest wall, her surgeons said (Northwestern Medicine via AP)
The patient was not identified but Dr Bharat said she had recently moved to Chicago from North Carolina to be with her boyfriend.
She was otherwise pretty healthy but her condition rapidly deteriorated after she was hospitalized in late April.
Although COVID-19 was initially considered primarily a disease of the elderly and chronically ill, it quickly became clear that it does not spare the young.
The young woman is among nearly 40 percent of hospitalized patients who are young – under 55 years old.
She was admitted more than six weeks ago – and has spent most of the intermittent time in the ICU at Northwestern.
Most patients spend 10 to 12 days in the ICU, and the fatality rate for patients on ventilators was 80 percent at the height of the epidemic in the US.
In addition to a ventilator, the young woman was kept alive using an ECMO machine that removes blood from her body, adds oxygen to it, and returns it. Pictured: A Northwestern team in full PPE operates and monitors the ECMO machine
Doctors had to hook the young patient up to both a ventilator and an extracorporeal membrane oxygenation (ECMO) machine, which removes oxygen-depleted blood from the body, infuses it with much needed oxygen and returns it to the body.
‘For many days, she was the sickest person in the COVID ICU – and possibly the entire hospital,’ said Dr Beth Malsin, a pulmonary and critical care specialist at Northwestern, who helped carefor the young woman.
Anxiously, her medical team watched the woman for weeks and weeks.
Overall, the case fatality rate for young people with coronavirus is low.In New York City as of this week, only about 0.02 percent of coronavirus patients between ages 18 and 44 died of the disease.
The patient’s medical team had to wear full PPE while seeing her and other COVID-19 patients in the ICU. They had to wait for her to clear the virus before it was safe to operate
Lung transplant surgeon Dr Bharat performed the 10 hour operation at Northwestern Memorial Hospital (pictured with a surgical robot)
Even the foremost experts are still puzzled as to why some young people become so devastatingly ill and die from the disease.
‘How did a healthy woman in her 20s get to this point?’ pondered Dr Tomic.
‘There’s still so much we have yet to learn about COVID-19. Why are some cases worse than others? The multidisciplinary research team at Northwestern Medicine is trying to find out.’
One explanation being explored by scientists around the world is genetics. Recent research suggests that a section of DNA that determines blood type may also be linked to risks for severe infection.
Remarkably, after six weeks, the woman cleared the virus – but for her lungs, the damage was done.
‘A lung transplant was her only chance for survival,’ said Dr Bharat.
Once she had definitively tested negative for the virus, he and his team listed the patient for a double-lung transplant and found a match within 48 hours.
‘There were so many times, day and night, our team had to react quickly to help her oxygenation and support her other organs to make sure they were healthy enough to support a transplant if and when the opportunity came,’ said Dr Maksin.
‘One of the most exciting times was when the first coronavirus test came back negative and we had the first sign she may have cleared the virus to become eligible for a life-saving transplant.’
Dr Ankit Bharat (pictured, in 2014) performed a 10-hour lung transplant for the woman with severe lung damage from the coronavirus, at Northwestern Memorial Hospital. The procedure was challenging because the virus had left her lungs full of holes and almost fused to chest wall, he said (Northwestern Medicine via AP)
Lungs accounted for just 7 percent of the nearly 40,000 US organ transplants last year. They are typically hard to find and patients often wait weeks on the transplant list.
Only a handful of transplants have been performed on coronavirus patients around the world.
The Chicago patient was in bad shape, with signs that her heart, kidneys and liver were beginning to fail, so she quickly moved up in line, Bharat said.
If a transplant had been performed earlier, the surgeons would have risked high levels of exposure to the virus, as well as contamination of the operating room, which could in turn have allowed the virus to spread even more rapidly throughout the hospital.
When the young woman’s surgical team removed her diseased lungs, they found some of the worst damaged organs they’d ever seen. Her lungs were blackened, scattershot with holes and marred by bleeds.
Despite the odds stacked against her, the patient made it through the operation and, although she’ll have to take immune-suppressing drugs to keep her body from rejecting her new lungs, she’s expected to make a full recovery and live a mostly normal life.
‘We want other transplant centers to know that while the transplant procedure in these patients is quite technically challenging, it can be done safely, and it offers the terminally ill COVID-19 patients another option for survival,’ said Dr Bharat.